Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Forms and Documents

Document Name	Status
Testing GovDelivery Form	New
CDC Digital Health Tools Evaluation Form	New
CDC Spanish Homepage Survey Form	New
CDC Flu Site - Card Sort Form	New
CDC Homepage Post-launch Survey Form	New
Testing Clear Communication Index Website Form	Modified
CDC Homepage UX Form	Modified
Testing of Sample Materials Developed Using the CDC Clear Communications Index Form and Instruction	Modified
CDC Homepage Mobile & Desktop Survey Form	Modified
Solve the Outbreak iPad Survey Form	Modified
Vital Signs Survey Form and Instruction	Modified
change for 0920-0956.docx Justification for No Material/Nonsubstantive Change	2014-02-20
Att.B_9-Before-Policymakers-Budget.pdf Supplementary Document	2014-02-20
Att.B_2-After-Clinicians-Flu.pdf Supplementary Document	2014-02-20
GenIC_Index Web Survey.corrected.docx Supplementary Document	2014-02-12
Att.L Recruitment Materials.docx Supplementary Document	2014-02-12
Att.B_16-After-Health-Departments-NVDRS.pdf Supplementary Document	2014-02-12
Att.B_15-Before-HealthDept-NVDRS_2013.12.12.pdf Supplementary Document	2014-02-12
Att.B_14 -After-Health-Departments-MAHC.pdf Supplementary Document	2014-02-12
Att.B_13-Before-Health-Departments-MAHC.pdf Supplementary Document	2014-02-12
Att.B_12- After-Policymakers-Epidemiology.pdf Supplementary Document	2014-02-12
Att.B_11-Before-Policymakers-Epidemiology.pdf Supplementary Document	2014-02-12
Att.B_10-After-Policymakers-Budget.pdf Supplementary Document	2014-02-12
Att.B_8-After-Partners-Heart-Disease.pdf Supplementary Document	2014-02-12
Att.B_7- Before-Partners-Heart-Disease.png Supplementary Document	2014-02-12
Att.B_6-After-Partners-HAI.pdf Supplementary Document	2014-02-12
Att.B_5- Before-Partners-HAI.png Supplementary Document	2014-02-12
Att.B_4- After-Clinicians-Wisconsin.pdf Supplementary Document	2014-02-12
Att.B_3-Before-Clinicians-Wisconsin.pdf Supplementary Document	2014-02-12
Att.B_1-Before-Clinicians-Flu.pdf Supplementary Document	2014-02-12
Att.A-Web Survey Protocol.docx Supplementary Document	2014-02-12
E-Scenarios -CDC_STOapplication_UX_01_07_2014 - OMB.docx Supplementary Document	2014-01-10
C-Consent Forms -CDC_STOapplication_UX_01_07_2014 - OMB.docx Supplementary Document	2014-01-10
B-Instructions -CDC_STOapplication_UX_01_07_2014 - OMB.docx Supplementary Document	2014-01-10
A-Protocal -CDC_STOapplication_UX_01_07_2014 - OMB.docx Supplementary Document	2014-01-10
fast-track-PRA-submission-short-form-cdc_Solve the Outbreak iPad Usability Protocol_01_07_2014.docx Supplementary Document	2014-01-10
D-Scenarios -CDChomepageUX121613 - OMB.docx Supplementary Document	2013-12-16
C-Consent Forms -CDChomepageUX121013 - OMB.docx Supplementary Document	2013-12-16
B - Instructions -CDChomepageUX121613 - OMB.docx Supplementary Document	2013-12-16
A-PROTOCOL-CDChomepageUX121013.docx Supplementary Document	2013-12-16
fast-track-PRA-submission-short-form-cdc-CDChomepageUX121613.docx Supplementary Document	2013-12-16
Attachment1_CDC-Index-Click-testing-Protocol_2013.11.07.docx Supplementary Document	2013-11-20
List of Attachments for Testing of Sample Materials Developed Using the CDC Clear Communications Index.docx Supplementary Document	2013-11-20
GenIC_Index Click Test 2013.11.06.docx Supplementary Document	2013-11-20
fast-track-PRA-submission-short-form-cdc homepage mobile desktop.doc Supplementary Document	2013-09-04
Solve the Outbreak User Zoom Questions.docx Supplementary Document	2013-06-26
Surveytemplate _SolvetheOutbreak.docx Supplementary Document	2013-06-26
Survey1template _VitalSignsv2.docx Supplementary Document	2013-06-11

IC Document Collections

IC ID	Document Title	Status
214226	Testing GovDelivery Form	New
213571	CDC Digital Health Tools Evaluation Form	New
212305	Solve the Outbreak Mobile App Survey Other-WORD	New
212251	CDC Spanish Homepage Survey Form	New
212040	CDC Social Media Satisfaction Survey Other-WORD	New
211673	CDC Flu Site - Card Sort Form	New
211632	CDC Homepage UX -- After Release Other-WORD	New
211032	CDC Homepage Post-launch Survey Form	New
210376	Testing Clear Communication Index Website Form	Modified
210038	Solve the Outbreak (14GM) Other-Screenshots	Modified
209701	CDC Homepage UX Form	Modified
209487	Testing of Sample Materials Developed Using the CDC Clear Communications Index Form and Instruction	Modified
208545	CDC Homepage Mobile & Desktop Survey Form	Modified
207575	Solve the Outbreak iPad Survey Form	Modified
207398	Vital Signs Survey Form and Instruction	Modified

ICR Details

OMB Control No: 0920-0956	ICR Reference No: 201402-0920-015
Status: Historical Active	Previous ICR Reference No: 201303-0920-011
Agency/Subagency: HHS/CDC	Agency Tracking No: 21469
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/27/2014
	Date Received in OIRA: 02/25/2014
Terms of Clearance: Previous terms continue: OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the agency must do the following: 1) Unless an agency is using multiple modes of collection (e.g., paper forms and electronic submissions), provide a Generic Clearance Submission Template for each Instrument; 2) If the agency is using multiple modes of collection (e.g., paper forms and electronic submissions), the same Generic Clearance Submission Template may be used for both instruments; 3) each Generic Clearance Submission Template must be uploaded as a Supplementary document using a naming convention that allows the public to identify the associated instrument; 4) submit no more than five Generic Submission Templates with each request.¿

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2016	03/31/2016	03/31/2016
Responses	30,750	0	10,250
Time Burden (Hours)	15,750	0	5,250
Cost Burden (Dollars)	0	0	0

---

Abstract: This request for nonsubstantive change is to correct an error made by CDC when the generic ICR was submitted. The number of responses and burden hours were entered for one year of information collection, and should have been tripled to account for the 3 years of clearance.

---

Authorizing Statute(s): US Code: 42 USC 41 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 15

IC Title	Form No.	Form Name
CDC Digital Health Tools Evaluation	none, none	CDC Digital Health Tools Survey ,   CDC Digital Health Tools Survey - word
CDC Flu Site - Card Sort	none	Card Sort Screenshots
Testing Clear Communication Index Website	none	Survey
Testing GovDelivery	none, none, none, none, none, none, none, none, none, none, none, none, none, none, none	Survey ,   Flu vaccine - screenshots - A ,   Flu vaccine - screenshots - B ,   Mental Health among Women screenshots - A ,   Mental Health among Women - screenshots - B ,   Environmental Health Training - screenshots - A ,   Environmental Health - Screenshots - B ,   Integrated Pest Management - screenshots - A ,   Integrated Pest Management - screenshots - B ,   Emergency Supplies - screenshots - A ,   Emergency Supplies - screenshots - B ,   Congenital Heart Defects - screenshots - A ,   Congenital Heart Defects - screenshots - B ,   Flu shots - screenshots - A ,   Flu shots - screenshots - B
Vital Signs Survey	None, None	Vital Signs Survey ,   Vital Signs Survey
Solve the Outbreak (14GM)	none	Questionnaire
Solve the Outbreak Mobile App Survey
Solve the Outbreak iPad Survey	none	Survey
CDC Homepage UX	none	Participant Scenario List
CDC Homepage Post-launch Survey	none	CDC Homepage Survey
CDC Spanish Homepage Survey	none, none	Spanish Homepage Survey ,   English Homepage Survey
CDC Social Media Satisfaction Survey
CDC Homepage Mobile & Desktop Survey	None, None	CDC Homepage Mobile and Desktop ,   CDC Homepage Mobile & Desktop Survey
Testing of Sample Materials Developed Using the CDC Clear Communications Index	None, None, None, None, None, None, None, None, None	Attachment 3: Flu Vaccine Information for Health Care Workers ,   Attachment 4: Autism and Developmental Disabilities Monitoring Network (ADDM) Tracking Autism in Wisconsin: What You Need to Know ,   Attachment 5: HAI Summary Data Reports: Questions and Answers ,   Attachment 6: Heart Disease Facts ,   Attachment 7: Use the Model Aquatic Health Code to Make Swimming Healthy and Safe ,   Attachment 8: The National Violent Death Reporting System (NVDRS): A Valuable Tool for Prevention ,   Attachment 9: CDC Priorities and FY 2014 Budget Request ,   Attachment 10: CDC Keeps America Healthy, Safe, and Secure. Case Study: Fort Leonard Wood, Missouri ,   Attachment 2: Click Testing Screen Shots
CDC Homepage UX -- After Release

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	30,750	10,250	0	20,500	0	0
Annual Time Burden (Hours)	15,750	5,250	0	10,500	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This change request is to add respondents and burden hours due to an error in the original clearance request.

---

Annual Cost to Federal Government: $36,130

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/25/2014

---